Medical Authorization Form

To request a copy of your Medical Record from Providence Medical Center, print off the linked form here, and mail or fax that form along with a copy of your official state ID to 913-596-4461.

If you have questions, feel free to call us at 913-596-4162, Monday through Friday, 8 a.m. to 4:30 p.m.

Click here to obtain our Authorization For Release of Information Form.

Featured Services

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Emergency Services

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Heart and Vascular

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Maternity Care

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Neurosciences

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Orthopedics

General Surgery 1

Surgical Services